Congenital Breast Surgery
Breast asymmetry is common, if not present to some degree in all women. Slight breast asymmetry may not be noticeable, but moderate to large differences in size and shape may be a source of physical or social discomfort, and/or frustration with finding bras and clothing. Difficulties in compensating for the size difference, self consciousness in clothing, and problems with breast feeding, are all common complaints of women inquiring about correction of breast asymmetry.
Congenital breast problems are sometimes apparent early in life, but usually become a noticeable as the breast develop. Congenital breast deformities may range from slight asymmetry to a lack of breast any development. These deformities can lead to significant functional, aesthetic and psychological concerns that can affect many aspects of the patient’s life. Dr. Trussler can help patients with nearly any type of breast deformity with a main goal of restoring a normal appearance and symmetry to both breasts.
What Are My Options?
Reconstructive and cosmetic procedures are available for a wide range of congenital breast deformities, including:
Breast Asymmetry: different sized and shaped breasts.
Tuberous Breast Deformities: tight breast skin with enlarged areola and herniated breast tissue in the areola.
Accessory Breast Tissue: presence of additional breast tissue, commonly in the armpit area.
Inverted Nipples: caused by tethering of short ducts under the nipples.
Enlarged Nipples: large and/or long nipples.
Extra or Third Nipple: commonly thought to be a skin tag under the breast.
Large Areola: large area of dark skin around the nipple.
Lack of Breast (Amastia): rare condition involving no breast or areola development.
Lack of Nipples (Athelia): condition known as athelia, usually coincides with lack of breast.
Poland Syndrome: underdeveloped chest muscles and breast with upper extremity deformities.
Dr. Trussler will listen to your goals and evaluate your concerns to help develop a realistic plan for correction. The treatment options for congenital breast problems include combinations of: breast implants, tissue expanders, breast lifts (mastopexy), breast reduction, nipple reconstruction, nipple reduction, and fat grafting.
Ideal candidates for congenital breast surgery are women with deformities of the breasts that cause medical problems, low self-esteem, physical or social discomfort, and/or frustration with finding bras and clothing. Women should be at a normal body weight or have attempted weight loss through diet and exercise. Patients with gynecomastia or large breast(s) commonly have skin rashes that are difficult to treat in the folds of the breast and these should be treated aggressively prior to any surgical procedure. Women should wait at least 10 months after breast feeding before considering breast surgery.
Congenital breast surgery is commonly performed on young women who have not had any children, but are extremely bothered by their breasts. These younger women have a good chance of breast feeding if they become pregnant after the operation.
It is important for patients to understand the details and risks associated with this procedure. Dr. Trussler will discuss your breast problems, your goals and factor in the size and amount of reduction/addition to determine the right breast surgery for you.
Women considering a congenital breast surgery should take into account the type of scar pattern and the acceptability of a breast implant when sorting through the surgical options.
Not every patient is a candidate for every type of breast surgery that Dr. Trussler offers, though during the consultation process the right breast procedure for you will hopefully meet your expectations. A breast surgery does not negate the need to wear a bra after the procedure, though some supportive relief is commonly provided with firmer, lifted and smaller breasts. Achieving symmetry is one of the most common goals of the procedures. In cases of extreme asymmetry, correction of both breasts may be needed and realistic expectations and goals will be discussed. These corrections may need a minimum of two surgeries and the use of a tissue expander which gradually stretches tight breast skin.
The type of treatment performed for congenital breast deformities depends on the extent of each patient’s individual breast deformity. Dr. Trussler performs a wide range of procedures to correct congenital breast deformities, which may include chest wall reconstruction, breast implants, expandable implants, nipple and areola construction, excision of extra nipples, reduction of enlarged areola, reconstruction of nipples, and more.
Most of these procedures are performed under general anesthesia on an outpatient basis, although some may require a short hospital stay. The length of the procedure can vary significantly, but are usually 1 to 3 hours.
Breast Asymmetry: treatment may include breast implants to help match breast volume, a breast lift to help correct shape differences, and/or a breast reduction to decrease the size of one or both breasts.
Tuberous Breast Deformities: can be corrected in one or two surgeries, and usually require an expandable breast implant or permanent breast implant, a peri-areolar breast lift, and areolar reduction.
Accessory Breast Tissue: is commonly treated with a simple excision of the fatty accessory breast tissue.
Inverted Nipples: treated by the release of the tethered ducts under the nipples with dermal grafting to help maintain the projection of the nipples.
Enlarged Nipples: large and/or long nipples can be reduced in size with a very simple excision of the nipple tissue.
Extra or Third Nipple: can be treated with a simple excision of the nipple and any areola or breast tissue associated with it.
Large Areola: reduction of the areola can be performed as part of a breast lift or breast reduction.
Lack of Breast (Amastia): rare condition involving no breast or areola development which can be treated with multiple breast reconstruction techniques including tissue expansion, breast implants and nipple reconstruction.
Lack of Nipples (Athelia): treated with a local nipple reconstruction which can be an in-office procedure.
Poland Syndrome: underdeveloped chest muscles and breast with upper extremity deformities which can be treated with multiple breast reconstruction techniques including tissue expansion, Latissimus Dorsi myocutaneous flaps, and breast implants.
Breast implants can be used in congenital breast surgery to help even the volume and the shape of the breasts. Breast implants, either saline or silicone, are available in multiple shapes and sizes. The implant can be placed through multiple incisions, most commonly in the fold under the breast. The breast pocket is created through this incision, most commonly under the muscle, or over the muscle. At this point temporary breast implants are placed and the size and position of the breast implant is confirmed with the patient in the sitting position prior to choosing the final breast implant. The final breast implant is placed in the breast pocket after removal of the temporary sizer and irrigation of the breast pocket with anti-biotic irrigation. No drains are used for primary breast augmentation surgery. The incisions are closed with internal sutures and covered with a clear plastic dressing.
Breast Tissue Expander:
A tissue expander is a shaped breast implant that is gradually inflated with saline to help stretch and expand the breast tissue and skin, so a permanent breast implant can be placed safely. In congenital breast deformities, such as a tuberous breast, the lower breast skin and breast tissue is very tight and constricted forcing the breast tissue to protrude through the areola. A tissue expander is placed through multiple incisions, most commonly in the fold under the breast. The breast pocket is created through this incision, most commonly under the muscle, or over the muscle. The breast tissue expander (s) is placed and the size and position of the expander is confirmed with the patient in the sitting position. The breast tissue expander is gradually filled through a “port” which is located on the expander or connected to the expander through a buried tube (remote port).
- In congenital breast surgery a remote port is commonly used to make filling the expander more comfortable because it is located at the side of the breast rather than on the breast.
The breast tissue expander is filled gradually with saline through a needle which is percutaneously placed into the port during each fill or expansion. This is done in the office with topical anesthetic. The tissue expander is filled over a 3 to 6 month period to allow for gradual and comfortable expansion of the breast tissue. The period from breast tissue expansion to permanent breast implant placement is usually 6 months minimum.
- Expandable breast implants can be used in younger patients to gradually expand the developing breast and compensate for significant breast asymmetry.
In all breast lift procedures the incisions are made around the nipple areola to reduce its size and facilitate the ability to move it upwards. In a standard breast lift the excess breast skin is removed and then tightened around the repositioned nipple. In a mastopexy augmentation procedure, the breast is reshaped after the implant is placed under the muscle and then the excess breast skin is removed and tightened around the repositioned nipple. In an auto-augmentation, the breast tissue is wrapped around the nipple areola to give the appearance and firmness of a breast implant. The breast skin is then tightened around the repositioned nipple. The majority of breast incisions are closed with stitches under the skin. Dr. Trussler does place deeper supportive sutures which help support the breast over time. The nipple areola are sized so that they are round and equal in size. These incisions are closed with stitches that need to be removed though limit any scarring around the areola.
Breast reduction can be performed on one or both breasts for congenital breast asymmetry
- Traditional Breast Reduction Surgery – This technique involves an anchor-shaped incision or inverted T incision. It is ideal for women with very large breasts who need at least a 2 cup sized reduction. Scarring can be more apparent though the techniques enable the safe removal of tissue and extensive shaping of the breast. Skin, fat and breast tissue can be removed from the lower breast and the nipples and areolas are be reduced and repositioned as well.
- Vertical Incision Breast Reduction – Also known as short-scar, this technique involves incisions that extend around the areola and down to the breast crease for a lollipop shape. The incision may be extended by Dr. Trussler to a J type pattern if needed. Vertical incision breast reduction is ideal for women with moderately large breasts. The technique allows for shaping of the breasts with less scarring for women who do not require extensive tissue removal.
Nipple procedures can be combined with other reconstructive procedures or can be performed alone either in the office or in the operating room. Nipples can be untethered or reduced through small incisions in the nipple. These incisions are closed with absorbable sutures and often protective dressings are applied to help preserve the shape of the nipple. A nipple and areola can also be reconstructed with local skin flaps or skin grafts if no nipple or areola exists.
After Care & Recovery
After any type of breast procedure, patients will likely experience mild soreness and swelling for a few days. The nipple areola will have a non-adherent gauze placed on them that will be removed in 2 days.
- Surgical drains are typically not used in these procedures unless in some cases of previous breast implant removal or tissue expansion. These drains are usually removed within one week of the procedure.
The breasts will be supported in a soft surgical bra for about three weeks or until healed. A sports bra can be substituted, but underwire bras are discouraged until the breast are completely healed which is commonly 6 weeks. Any stitches will be removed after one or two weeks. Most patients will be able to return to work or school within a week, although exercise and other strenuous activity should be avoided for about a month. Breast implant exercises are not needed in lift and implant procedures because they can disrupt internal supportive sutures. Dr. Trussler will provide you with specific instructions for your individual recovery.
The results of a congenital breast surgery are often visible immediately after surgery and will continue to improve as swelling subsides and scars fade. The breast shape will evolve over a three month period especially in the cases of mastopexy augmentations and in tissue expansion. Scar treatment will be initiated at the 3 week visit and may be continued for 3 to 6 months after the operation, or until the scar soften and fade. As previously mentioned a bra must still be used after a breast asymmetry procedure, but cup size and need for support may decrease in the standard breast lift and breast reduction patient.
Whether you have a question or would like to setup a congenital breast surgery consultation, Dr. Trussler and his staff are here to help. Please fill out our contact form, or call our office at 512-450-1077 to schedule an appointment. Start your journey to not only looking, but feeling better today!